Many of Pakistan’s major hospitals which provide crucial medical care to the masses, from Lady Reading in Peshawar to Karachi’s Civil Hospital, were constructed during British colonial times (see The hospitals Pakistan did not build below for more details).
Countless hospitals were built and operational before 1947, but post-Partition, the government built very few hospitals that could be accessed by the public.
Twelve years after independence, Ayub Khan’s government tried to develop an infrastructure consisting of a basic health unit, a rural health centre, a taluka head quarter, a district general hospital to tertiary healthcare centres known as teaching hospitals.
Pakistanis owe their tertiary healthcare system to the British, after Partition the government has made little effort to build more hospitals
Under the helm of a USAID programme, centres like the National Institute of Cardiovascular Disease were established to provide tertiary healthcare to people with heart disease who need emergency treatment. USAID also helped develop the Basic Medical Sciences Institute (BMSI) at the Jinnah Postgraduate Medical Centre and at other places in Pakistan.
Despite support from the US development agency, the healthcare infrastructure did not survive in Pakistan due to a lack of interest by our leaders and the non-cooperation of health professionals who were not interested in an organised healthcare system in Pakistan.
Donors such as USAID can construct a building and equip the hospital with modern instruments but they cannot inject honesty and competency in a politically-motivated administration.
Pakistan’s policymakers lack political vision
All over the world doctors are more interested in their private practice but politicians and policymakers in coordination with dedicated doctors have been able to develop healthcare systems for the benefit of general public. Sweden, UK, France, and Turkey are countries where such healthcare systems have been established with great success.
The government of these countries were able to develop an organised and structured teaching and training programme in their tertiary care hospitals to produce competent medical specialists who could practice medicine ethically after graduation. Politicians in Pakistan, unfortunately, had no vision for public health and a majority of doctors in the country are only interested in money and power.
For all practical purposes, a proper tertiary healthcare system is not available in the public sector in Pakistan. No political leader or well-to-do government officer would choose to seek treatment for themselves or for their families at a public hospital for treatment.
The only exceptions are people who are too poor and can’t afford treatment at private hospitals or those like Abdul Sattar Edhi, who apparently chose to be admitted into a public hospital due to his ideology of simplicity rather than his trust in medical care at such facilities.
Why no one goes to public hospitals out of choice
Every day on our national television we watch the poor conditions of emergency-care facilities, overcrowded out-patients departments and miserable management of patients in wards.
We have more than 70 medical and dental colleges in the public sector with enough financial support to run the attached tertiary care teaching units but no sane person wants to go to these centres to seek treatment for any illness. The reasons are very simple. We all know that none of the government hospitals provide full-time, 24/7 service.
Usually all faculty members work on a part-time basis and the majority of patients are managed by trainee junior doctors. The crucial decisions are taken by very junior staff at odd hours when the faculty members are usually busy in private practice. This is the reason we often witness violent behaviour of patients’ relatives when they lose their loved ones from mismanagement or other complications.
Poor patients are the victims of bad governance and poor policies adopted by governments, as well as strikes by doctors who are least bothered about the patients or the profession.
There are rare exceptions in different cities of the country but there is no organised and efficient system that exists in our teaching hospitals attached to medical college and universities in every province of Pakistan.
Private hospitals are no better
In most private health facilities, tertiary care is not ideal. There is no accountability and transparency as far as the management and professional fees are concerned. The hospitals usually fail to provide the care they are supposed to give after charging enormous fees from patients.
I was ashamed and shocked when, as secretary general of Pakistan Medical Association, I was shown some hospital bills by a CEO of a large corporation in which a battery of laboratory tests were carried out without any rhyme or reason on their patients.
There were some very strange cases in which male patients were charged for pregnancy tests; and some patients on life-support ventilators were charged for ECG on a six- hourly basis. The company was paying all these bills till it was discovered accidentally by a responsible officer in the accounts department.
I was speechless and had no explanation for this dishonesty.
Many public sector organisations such as Pakistan Railways, Pakistan International Airlines, Pakistan Steel Mills and the Department of Auqaf have their own hospitals which serve vested-interest groups without a system of accountability.
Some of these systems were established by the British for the benefit of their employees but successive governments destroyed this system effectively for the benefit of a chosen few.
What can and should be done?
It is time to bring revolutionary changes in our tertiary care hospitals, and in our postgraduate teaching and training programmes.
All tertiary care hospitals should be declared autonomous and should be able to take decisions independently without interference from politicians and civil servants.
All appointments of vice chancellors, principals, deans, professors and lecturers should be made on merit without the interference of vested interest groups and politicians.
All faculty members should be employed on a full-time basis with very good salaries and should not be allowed to indulge in private practice.
There is a need for a structured teaching and training programme for young doctors in all tertiary care hospitals to produce competent and skilled medical specialists who can practice ethically in the community after completion of their training.
All our medical universities, medical colleges and tertiary care centres have enough financial support to provide ideal care to patients. We have often astounding transformations when a dedicated, honest and competent person is made in charge of a health facility as long as he or she is allowed to run the centre in a professional way without any interference.
Tertiary care centres in the private sector should also be made accountable and a system of audit should be introduced for the benefit of patients who are, by and large, not even informed about the mishap and negligence on the part of the hospital.
Honest and ethical owners of private hospitals will welcome any serious initiative for the benefit of patients. Private tertiary care centres should also conduct structured postgraduate training and teaching programmes for young doctors.
In Khyber Pakhtunkhwa, the government is moving in the right direction in their goal to improve tertiary care at teaching hospitals but it will be successful only if the system is based on merit and the right people are selected.
According to government statistics, there are 1,142 hospitals with a bed capacity of 118,041. However, a majority of these hospitals are not functional and they fail to provide minimal standard of care to patients who need emergency medical care in or suffer from a chronic illnesses.
Despite being a nuclear power and a nation of wealthy politicians, the common people in Pakistan will continue to suffer unless its rulers, civil society, intelligentsia and politicians reach a consensus to bring revolutionary changes in our system.
Published in Dawn, Sunday Magazine, August 7th, 2016